Provider Demographics
NPI:1851793301
Name:HIGH PEAK ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:HIGH PEAK ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LIC AC
Authorized Official - Phone:518-306-1221
Mailing Address - Street 1:103 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:CAROGA LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12032-5411
Mailing Address - Country:US
Mailing Address - Phone:435-640-3472
Mailing Address - Fax:
Practice Address - Street 1:3 FRANKLIN SQ
Practice Address - Street 2:SUITE 3
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2153
Practice Address - Country:US
Practice Address - Phone:518-306-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005076-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty